Joint Interventions Research Articles

Joint Human and Animal Health Campaigns in Chad

Abstract Providing basic health services to nomadic populations is challenging mainly because of their mobility affecting geographical access to essential services but also due to their particular cultural habits and beliefs, influencing health intervention acceptance. The strategy of joint human and animal health campaigns applied in Chad for over 30 years has helped to improve coverage of childhood and livestock vaccination and increased access to disease prevention. The campaigns are organized by the Chadian ministries for public health and livestock, supported by the Swiss Tropical and Public Health Institute (Swiss TPH) and its local partners. The use of synergies across sectors intends to reduce costs compared to independent sectoral interventions. The gain lies not only in shared logistics but also in better trust in essential services by pastoralists. Planning of joint interventions should start with a careful assessment of the context through a transdisciplinary approach identifying possible access barriers. This allows multidisciplinary development of mitigation measures such as a locally adapted awareness strategy. The multi-disciplinary approach also provides information on the seasonal movements of the different pastoral groups, which is crucial for the timing and location of interventions. Administrative and technical preparation of the field visits needs concerted efforts by all ministries and partners involved to maximize the benefits. To facilitate the uptake and sustainability of joint campaigns in Chad, the involved partners together developed an implementation guide based on their long-standing experience. This case report draws on this guiding document and showcases it for other actors interested in implementing similar One Health strategies. Information © The Authors 2024

Complications of revision knee arthroplasty

Due to the growing scale of arthroplasty and the widening of indications for knee joint replacement, the durability of joint functioning has become a critical issue. Untimely diagnosis and inadequate treatment of patients with endoprosthesis component loosening leads to major bone defects. This problem arises from repeated joint interventions, large bone defects and duration of revision surgeries, that is fraught with catastrophic consequences for patients – revision prosthesis removal or even limb amputation. The project aims to improve the treatment for patients with instability of components after knee joint arthroplasty. The aim of the study is to analyze the results of revision knee arthroplasty and identify the causes of mistakes and complications of revision arthroplasty with the intention of prevention. Materials and methods. A retrospective analysis of 50 revision knee arthroplasties performed at the Centre for Arthroplasty of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” was conducted. Clinical and radiological findings were evaluated for all patients. All revision prostheses used in this study were of the semi-constrained type. Cementation technique was used for all implants. In the revision of the septic complication group, a full cementation technique with antibiotics according to a sensitivity profile were used, while in the aseptic complication group, a surface cementation technique with antibiotics according to sensitivities were used. Results. The authors of the project have analyzed the results of treatment of 50 revision arthroplasty procedures performed between 2013 and 2022 for instability of the endoprosthesis components. The structure of complications has been examined and the causes of failure in revision knee arthroplasty have been identified. This study has shown promise in preventing complications and developing personalized approaches to revision arthroplasty. Conclusions. The analysis of revision knee arthroplasty failure has shown the prevalence of septic complications (56.0 %). In the case of septic complications after revision arthroplasty, Staphylococcus aureus prevailed (57.1 %), gram (-) microorganisms were causative agents in other cases. Factors resulting in aseptic complications included those associated with the surgical intervention (81.8 %), the patient (45.4 %) and the combination thereof (72.7 %). Significant causes of the femoral revision component loosening were residual valgus deformity, medial instability in the frontal plane; significant causes of the tibial component loosening were residual varus deformity and lateral instability in the frontal plane.

If we cooperate together, we intervene together: Defense cooperation agreements and support to conflict parties

As governments increasingly turn to defense cooperation agreements (DCAs) to institutionalize defense relations, there is little scholarly knowledge of the impact of these agreements in civil wars. Are DCA partners more likely to militarily intervene in civil conflicts together compared with countries without DCAs? While studies show that formal alliance commitments impact the likelihood of parties participating in foreign interventions, DCAs have received little attention in the literature even though DCAs between partner states are signed frequently and subject to change. This study argues that partners in DCAs are likely to provide external military support to the same conflict parties. Our theoretical model suggests that DCAs provide an arena for socialization where governments and military organizations that are DCA partners have repeated interactions. As a result of socialization, their foreign policy goals increasingly align, including their approach to military intervention in foreign conflicts. With access to similar weapons material, military training, and information, DCAs facilitate joint interventions between partner states. Examining the probability of intervention in civil conflicts during the period of 1980–2009, we find that countries that are DCA partners are more likely to provide military assistance to the same warring parties compared with countries without DCAs.

Influence of health-related behaviors patterns on obesity among primary and secondary school students: A latent profile analysis.

To analyze the co-existing patterns of health-related behaviors among children and adolescents at different education stages and the association with obesity. Cross-sectional study. A total of 5651 primary and secondary school students were drawn from the National Student Physical Health Survey in 2014 with an average age of 13.53±2.87 years. Physical measurements and questionnaires were completed, which concluded height, weight, and health-related behaviors (sleep, physical activity, dietary, and screen behavior etal.). Latent profile analysis (LPA) was conducted using Mplus 8.3 and SPSS 26.0 was used for other statistical analysis. Three latent classes of health-related behaviors were fitted for each of the education stages. After adjustment for age, gender, and region, the high-screen behavior group were 2.217 (95%CI=1.030-4.772, p=.042) times more likely to be obesity than the health-behavior group in primary school, and the poor-diet group and poor-diet and high-screen behavior group were 2.101 (95%CI=1.396-3.396, p<.001) and 1.788 (95%CI=1.003-3.190, p=.049) times more likely to be overweight than the health-behavior group in junior middle school respectively. Obesity is mainly influenced by screen behavior and dietary patterns among children and adolescents. Health-related behavior patterns should be accurately identified and comprehensive joint interventions should be carried out to prevent obesity.

Comparative efficacy of non-pharmacological interventions on sleep quality in old adults: A systematic review and network meta-analysis.

To compare the effectiveness of non-pharmacological interventions in enhancing sleep quality in older people. Sleep problems in older adults have become increasingly prominent. Sleep problems not only affect the health and quality of life of older people, but also the range of chronic diseases caused by sleep problems also impose a huge burden on social services and health care. Non-pharmacological interventions are an effective alternative to pharmacological therapies, but it is unclear which non-pharmacological therapies are most effective in enhancing sleep quality in older adults. A systematic review and network meta-analysis based on PRISMA-NMA. A total of seven databases were searched from the establishment of the database to March 2023. After literature screening and data extraction, the Cochrane Bias assessment tool 2.0 version of randomised controlled trials (RCTs) was used to evaluate literature quality. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on sleep quality. A total of 71 RCTs involving nine non-pharmacological interventions were included. The results of the network meta-analysis showed that the joint intervention may be the most effective non-pharmacological intervention to enhance sleep quality in older adults. This study confirms that non-pharmacological interventions can improve sleep quality in older adults. The use of non-pharmacological interventions can be promoted by healthcare professionals in the future to improve the quality of sleep and thus the physical and mental health of older people. This evidence suggests that joint interventions may be most effective. Therefore, in the future, a combination of non-pharmacological interventions could be used to maximise their effectiveness in improving sleep quality in older people and promoting healthy aging. No patient or public contribution is not applicable to this study.

Social-ecological perspective on the suicidal behaviour factors of early adolescents in China: a network analysis

BackgroundIn early adolescence, youth are highly prone to suicidal behaviours. Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.AimsTo explore the risk...

Model-based analysis of the incidence trends and transmission dynamics of COVID-19 associated with the Omicron variant in representative cities in China

BackgroundIn 2022, Omicron outbreaks occurred at multiple sites in China. It is of great importance to track the incidence trends and transmission dynamics of coronavirus disease 2019 (COVID-19) to guide further interventions.MethodsGiven the population size, economic level and transport level similarities, two groups of outbreaks (Shanghai vs. Chengdu and Sanya vs. Beihai) were selected for analysis. We developed the SEAIQRD, ARIMA, and LSTM models to seek optimal modeling techniques for waves associated with the Omicron variant regarding data predictive performance and mechanism transmission dynamics, respectively. In addition, we quantitatively modeled the impacts of different combinations of more stringent interventions on the course of the epidemic through scenario analyses.ResultsThe best-performing LSTM model showed better prediction accuracy than the best-performing SEAIQRD and ARIMA models in most cases studied. The SEAIQRD model had an absolute advantage in exploring the transmission dynamics of the outbreaks. Regardless of the time to inflection point or the time to Rt curve below 1.0, Shanghai was later than Chengdu (day 46 vs. day 12/day 54 vs. day 14), and Sanya was later than Beihai (day 16 vs. day 12/day 20 vs. day 16). Regardless of the number of peak cases or the cumulative number of infections, Shanghai was higher than Chengdu (34,350 vs. 188/623,870 vs. 2,181), and Sanya was higher than Beihai (1,105 vs. 203/16,289 vs. 3,184). Scenario analyses suggested that upgrading control level in advance, while increasing the index decline rate and quarantine rate, were of great significance for shortening the time to peak and Rt below 1.0, as well as reducing the number of peak cases and final affected population.ConclusionsThe LSTM model has great potential for predicting the prevalence of Omicron outbreaks, whereas the SEAIQRD model is highly effective in revealing their internal transmission mechanisms. We recommended the use of joint interventions to contain the spread of the virus.

Improving myocardial infarction emergency care: a joint intervention study of the Berlin Brandenburg Myocardial Infarction Registry (B2HIR) and emergency medical services (QS-Notfall)

Abstract Background Rapid myocardial reperfusion is needed to improve clinical outcome after a ST-elevation myocardial infarction (STEMI). Missed early explicit STEMI diagnoses were shown to unfavourably delay STEMI care. A networked approach between emergency medical systems (EMS) and cardiology hospital departments is useful to establish early valid pre-hospital STEMI diagnoses. Purpose The publicly funded "QS-Notfall" joint health services research study intended to improve STEMI care in Berlin (BE) and Brandenburg (BB) by implementing pre-hospital tele-ECG transmission and online ECG training for EMS personnel. Methods As part of B2HIR, 21 cardiology hospital departments (19 in BE, 2 in BB) together with EMS (BE firefighters and regional BB EMS), supported by the Berlin Medical Chamber, established 2 joint interventions to accelerate STEMI care. All EMS and hospitals implemented GDPR compliant telemedical transmission and structured handling of pre-hospital ECGs from patients with chest pain. In addition, we developed an ECG e-learning for emergency physicians and EMS personnel ("STEMI einfach erkennen") and communication between EMS and hospitals was enforced. Patients with acute myocardial infarction (AMI) and symptom onset ≤24h were enrolled. Symptom onset, first medical contact, time of hospital admission ("door"), time of guidewire passage into the coronary artery (reperfusion), and respective care delays were assessed. First obtained ECGs were blindly validated by 3 expert cardiologists. We compared a reference period to a 12-month intervention period with regard to care delays. In addition, STEMI care was analyzed according to the actual use of telemedical ECG transmission and according to the validity of ECG diagnoses. Results N=7303 cases were enrolled (reference period 3657, intervention period 3646, age 66.9y, 27.1% female, STEMI 49.4%). The usage of ECG transmission varied notably between hospitals (7.5%–74%). Tele EMS ECG usage in STEMI was associated with shorter door to reperfusion time (BB 11min, p&amp;lt;0.04, BE 12min, p&amp;lt;0.001) compared to STEMI care w/o ECG transmission. The difference was more pronounced during hospital off-hours (BB 30min, p=0.003 and BE 14min, p&amp;lt;0.001). An unmistaken EMS STEMI diagnosis related to a shorter door to reperfusion time (BE: by 106min; BB: by 49min) compared to an unsettled STEMI diagnosis (p&amp;lt;0.001). The rate of ECG transmission for STEMI patients in BE was 21.4%, in BB 55.7%. Accordingly, we found no significant difference in STEMI door to reperfusion delays between the reference period and the intervention period in BE (+1min) and a shorter reperfusion delay (by 11min) in BB (p=0.049). Conclusions The universal implementation of a joint intervention to improve STEMI care in a complex system of various EMS and hospital departments is challenging. Telemedical ECG transmission and an unmistaken early STEMI diagnosis are associated with a significantly shorter time delay to myocardial reperfusion.

Capturing and quantifying the aggregate effects of multi-source factors affecting miners' health and well-being: Construction of Bayesian belief networks.

Factors originating at the organizational, work, and individual levels are closely interrelated and intricately intertwined, affecting health rates. There was limited research on the interdependence and aggregate effects between multi-source factors and occupational health and well-being (OHW). It is challenging to achieve management goals. Therefore, considering cross-level factors and across the "work environment-stress-exposure-OHW" chain, individual vulnerability was considered. A Fuzzy Bayesian Belief Network (FBBN) driven by both domain knowledge and data was constructed to carve out the logic between multi-source factors and OHW. Workers from four coal mines were surveyed twice in 6months. 714 valid samples were included in the analysis. The interdependencies among multi-source factors were identified by the Interpretive Structure Modeling method and the visual probability estimation was achieved based on FBBN. It revealed that the work and the organizational level were the root factors. Eight factors involved in work stress were mainly mediating, and actual exposure and individual vulnerability were direct factors. Pathway interventions and joint interventions were proposed. The prediction ability and scheme feasibility of FBBN were verified. The approach developed allows robust assessments of aggregate effects and obtains multi-source factor importance. This study provides vital insights and evaluation tools for understanding workplace stress and OHW management.

Integrated Extensive Detection, Contact Tracing and Dynamical Social Distancing Interventions to Prevent Future Epidemic Waves

In the absence of sufficient vaccination and rapid mutation of the virus, joint interventions of detection, contact tracing and social distancing are considered to be key strategies in suppressing emergent epidemics. Here, we propose the susceptible-exposed-infected-quarantined-recovered (SEIQR) model with detection, contact tracing, and dynamical social distancing to quantify the effectiveness of joint interventions. Under the framework of time-varying networks, we analytically derive the epidemic threshold and the effective reproductive number under joint interventions by using the mean-field approach. Experimental results show that detection and contact tracing can significantly reduce the epidemic scale, while social distancing can remarkably delay the peak time and suppress the second outbreak of the epidemic. Compared with constant social distancing, the effectiveness of dynamical social distancing depends on the starting time and the intervention period, and extensive detection can greatly reduce its dependence on them. Further, we explore the effects of heterogeneous distributions of physical distance and contact duration on the effectiveness of joint interventions in high-resolution empirical contact networks. We find that extensive contact tracing is more effective in decreasing the “false negatives”, but at the expense of unnecessary large-scale quarantines of the “false positives.” Meanwhile, the early implementation of long-term social distancing can effectively reduce the “false negatives” and “false positives.” In conclusion, it is very important to ensure extensive detection and contact tracing, while maintaining moderate social distancing to suppress the epidemic spread and prevent epidemic recurrence.

The effects of Ascophyllum nodosum, Camellia sinensis-leaf extract, and their joint interventions on glycolipid and energy metabolism in obese mice.

Obesity is often associated with glucolipid and/or energy metabolism disorders. Ascophyllum nodosum extract (seaweed extract, SE) and Camellia sinensis-leaf extract (tea extract, TE) have been reported to promote positive metabolic effects through different mechanisms. We investigated the effects of SE and TE on metabolic homeostasis in diet-induced obese mice and discussed their functional characteristics. Male C57BL/6J mice fed with high-fat diets for 8 weeks were established as obese models and subsequently divided into different intervention groups, followed by SE, TE, and their joint interventions for 10 weeks. Body weight and food intake were monitored. Fasting glucose and oral glucose tolerance tests were interspersed during the experiment. After the intervention, the effects on obesity control were assessed based on body composition, liver pathology section, blood lipids and glucose, respiratory exchange ratio (RER), energy expenditure (EE1, EE2, and EE3), inflammatory factors, lipid anabolism enzymes, and gut flora of the obese mice. After continuous gavage intervention, the mice in the intervention groups exhibited lower body weight (lower ~4.93 g, vs. HFD 38.02 g), peri-testicular fat masses (lower ~0.61 g, vs. HFD 1.92 g), and perirenal fat masses (lower ~0.21 g, vs. HFD mice 0.70 g). All interventions prevented diet-induced increases in plasma levels of glucose, adiponectin, leptin, and the inflammatory factors IL-1β and TNF-α. The RER was modified by the interventions, while the rhythm of the RER was not. Blood lipids (total cholesterol, triglycerides, and LDL) decreased and were associated with lower lipid anabolism enzymes. In addition, the SE and TE interventions altered the structure and abundance of specific flora. Different interventions inhibited the growth of different genera positively associated with obesity (Escherichia-Shigella, Helicobacter, etc.) and promoted the growth of Akkermansia and Bacteroides, thus affecting the chronic inflammatory state. SE and TE both have synergistic effects on weight control and glucolipid metabolism regulation by improving insulin sensitivity and reducing lipid synthesis-related enzyme expression, whereas the combination of SE and TE (3:1) has a better effect on regulating energy metabolism and inhibiting chronic inflammation.

Hypothetical interventions and risk of atrial fibrillation by sex and education: application of the parametric g-formula in the Tromsø Study.

To use the parametric g-formula to estimate the long-term risk of atrial fibrillation (AF) by sex and education under hypothetical interventions on six modifiable risk factors. We estimated the risk reduction under hypothetical risk reduction strategies for smoking, physical activity, alcohol intake, body mass index, systolic, and diastolic blood pressure in 14 923 women and men (baseline mean age 45.8 years in women and 47.8 years in men) from the population-based Tromsø Study with a maximum of 22 years of follow-up (1994-2016). The estimated risk of AF under no intervention was 6.15% in women and 13.0% in men. This cumulative risk was reduced by 41% (95% confidence interval 17%, 61%) in women and 14% (-7%, 30%) in men under joint interventions on all risk factors. The most effective intervention was lowering body mass index to ≤ 25 kg/m2, leading to a 16% (4%, 25%) lower risk in women and a 14% (6%, 23%) lower risk in men. We found significant sex-differences in the relative risk reduction by sufficient physical activity, leading to a 7% (-4%, 18%) lower risk in women and an 8% (-2%, -13%) increased risk in men. We found no association between the level of education and differences in risk reduction by any of the interventions. The population burden of AF could be reduced by modifying lifestyle risk factors. Namely, these modifications could have prevented 41% of AF cases in women and 14% of AF cases in men in the municipality of Tromsø, Norway during a maximum 22-year follow-up period.

Longitudinal correlates of bullying victimization among Chinese early adolescents: A cross-lagged panel network analysis

BackgroundBullying victimization is a major public health issue often faced by adolescents. This highlights the need to identify the relevant risk factors to inform intervention. Based on the ecological systems theory and applied cross-lagged panel network analysis, this study explored the longitudinal correlates of bullying victimization among Chinese early adolescents. MethodsA total of 1686 early adolescents (60.4 % were boys) from the Chinese Early Adolescent Cohort study were included in this study. Bullying victimization and its associated factors were assessed using the self-report questionnaires, which was administered from 2019 (T1), 2021 (T2), and 2022 (T3). The longitudinal relationships between bullying victimization and its correlates were examined using a cross-lagged panel network analysis. Results27.0 %, 14.9 %, and 13.2 % of the participants reported being bullied by peers at T1, T2, and T3, respectively. The temporal network suggested that individual-level (sex, depression, and anxiety), family-level (child abuse), school-level (satisfaction with classmates), and social-level (satisfaction with society) factors were associated with bullying victimization. The node with the greatest centrality strength was anxiety. Notably, relationship with teachers and classmates were the unique nodes in the T2 → T3 replication network. LimitationsThe sample is unrepresentative, as it is from only one middle school. ConclusionsThe findings provide important insights into bullying victimization prevention and intervention among Chinese early adolescents: 1) highlighting the importance of joint interventions across multiple departments; 2) focusing on the most central factors of bullying victimization; and 3) considering the effect of time when exploring the correlates of bullying victimization.

Exploring the Use of Facet Joint Injections Through Instagram.

Facet joint injection (FJI) is a minimally invasive procedure used to relieve pain and inflammation in the facet joints of the spine. In light of the growing presence of social media, it is essential to comprehend its effects on the healthcare industry. Little is known about how FJI is discussedon Instagram. Thepurpose of this study was to investigate the characteristics and production sources of FJI-related posts on Instagram. This study provides a descriptive analysis of Instagram posts with the keywords #facetjointinjection, #facetjointinjections,#facetinjection, #facetinjections, #facetblock, and #facetblocks onMarch 1, 2023. The results were categorized by source into four groups; posts created by healthcare professionals (surgeon/non-surgeon), medical organizations, patients, or not otherwise specified. The content was categorized by type (educational and patient/physician experience) and user influence (number of followers and posts). The search resulted in 2718 posts. Most post uploaders were mainly physicians (43.1%, n = 275). The distribution of remaining Instagram users with FJIs posts was as follows: 27.1% (n=173) patients, 16.3% (n=104) medical organizations, and 13.4% (n=86) not otherwise specified. Among theposts, 1136 (41.7%) were from accounts created by patients, 1015 (37.3%) by physicians, 441 (16.2%) by medical organizations, and 126 (4.6%) were unspecified.The analysis showed a significant difference in the distribution of posts among patients and physicians, as well as patients and other unspecified groups (p<0.05). The reported side effectswere as follows: pain around the injection site (36%), swelling (17%), weight gain (15%), and anxiety (32%). This study demonstrates that physicians are widely present on social media. However, when searching for posts about facet joint interventions, posts written by patients are more likely to be seen by the public. The results of this article emphasize the impact physicians have on online platforms and the need to raise FJI awareness on Instagram. Due to a lack of information and their anxiety about the unknown, patients have voiced hesitation about undergoing FJIs. To address this issue, it is the responsibility of physicians to enhance the accessibility of accurate information for patients in order to alleviate their anxiety. Additionally, reputable pain medicine societies and qualified specialists should upload credible posts on facet joint interventions that include accurate information, high-quality images and videos, and proper scientific commentary, with the aim of enhancing the quality of online health information.

Ultrasonography of the pediatric elbow.

Ultrasound of the elbow can be incorporated into routine pediatric practice in the radiology department, emergency department, orthopedic clinic, and interventional suite. Ultrasound is complementary to radiography and magnetic resonance imaging for the evaluation of elbow pain in athletes with overhead activities or valgus stress, focusing on the ulnar collateral ligament medially and capitellum laterally. As a primary imaging modality, ultrasound can be used for a variety of indications including inflammatory arthritis, fracture diagnosis, and ulnar neuritis/subluxation. Ultrasound is also well-suited to guide diagnostic and therapeutic elbow joint interventions with precise localization of anatomic landmarks and needle placement. Here, we describe technical aspects of elbow ultrasound and illustrate its application in pediatric patients from infants to teen athletes.

Invited Perspective: The Potential of Potential Outcomes in Air Pollution Epidemiology.

Invited Perspective: The Potential of Potential Outcomes in Air Pollution Epidemiology.

Outcomes of gout in patients with cirrhosis: A national inpatient sample-based study.

Hyperuricemia is a prerequisite for the development of gout. Elevated serum uric acid (UA) levels result from either overproduction or decreased excretion. A positive correlation between serum UA levels, cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established, but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes. We hypothesize that patients with cirrhosis will have poorer gout outcomes. To explore the link between cirrhosis and the incidence of gout-related complications. This was a cross-sectional study. The national inpatient sample was used to identify patients hospitalized with gout, stratified based on a history of cirrhosis, from 2001 to 2013 via the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcomes were mortality, gout complications and joint interventions. The χ 2 test and independent t-test were performed to assess categorical and continuous data, respectively. Multiple logistic regression was used to control for confounding variables. Patients without cirrhosis were older (70.37 ± 13.53 years vs 66.21 ± 12.325 years; P < 0.05). Most patients were male (74.63% in the cirrhosis group vs 66.83%; adjusted P < 0.05). Patients with cirrhosis had greater rates of mortality (5.49% vs 2.03%; adjusted P < 0.05), gout flare (2.89% vs 2.77%; adjusted P < 0.05) and tophi (0.97% vs 0.75%; adjusted P = 0.677). Patients without cirrhosis had higher rates of arthrocentesis (2.45% vs 2.21%; adjusted P < 0.05) and joint injections (0.72% vs 0.52%; adjusted P < 0.05). Gout complications were more common in cirrhosis. Those without cirrhosis had higher rates of interventions, possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.

Adoption and transferability of joint interventions to fight modern slavery in food supply chains

More than 50 million people in the world are estimated to be in a situation of modern slavery, the most extreme form of labour exploitation. Many of them are working in sectors such as mining and agriculture, which produce price-sensitive commodity products and where workers are particularly vulnerable. Against this challenge, we analyse a successful intervention against modern slavery in a place that has been labelled the “ground zero of modern slavery in the US”. The Fair Food Programme was established in the tomato growing industry in Immokalee, Florida, and is based on an innovative joint action between farmers, buyers, and workers. We use an agent-based model built on qualitative field data to explain the success of the programme and to investigate whether the programme could be successfully transferred to other contextual settings. We model several market structures and measure the time it takes for all actors in the system to join the Fair Food Programme after a shock event (such as a case of modern slavery being discovered) triggered a dynamic of joint action. Our model shows that a high heterogeneity in farmer sizes leads to an increase in the time taken for them all to join the Fair Food Programme, while a high heterogeneity in buyer sizes speeds up reaching the tipping point towards joint action. We discuss these results and their implications for the transferability of the Fair Food Programme as a voluntary, incentive-driven approach towards tackling modern slavery, to other locations and contexts.

Prevalence and Factors Associated with &amp;quot;Zero-Dose&amp;quot; in Children 12 to 23 Months in Togo

One of the priorities of the Immunization Agenda 2030 is to identify “zero-dose” children, and to adapt strategies in order to recover them. The study aimed to estimate the prevalence of “zero-dose” in children aged 12-23 months and determine the associated factors in Togo. This was a cross-sectional study which consisted in carrying out secondary analyzes of the databases of the Multiple Indicator Cluster Survey conducted in Togo in 2017. This study population consisted of children aged 12-23 months that had been successfully investigated during this survey. The dependent variable was the child's vaccination status (0 ="Vaccinated" vs 1 ="Zero-dose"). As for the explanatory variables, they were related to the child, the child’s mother, the household and the environment. Geospatial analyzes of child prevalence at “zero-dose” were performed using Arc GIS 10.5 software. Factors associated with “zero-dose” were identified through multivariate logistic regression. A total of 933 children under five were included in the study. The prevalence of “zero-dose” in children aged 12-23 months was 26.88% (95% CI= 23.50-30.55). We note that the factors associated with "zero-dose" in children aged 12-23 months in Togo were: the birth order of the child, the age, the level of education, the ethnicity, the religion of the head of household and the region of residence. Finally, our results can guide efforts to identify and reach children who have not received any vaccine. “Zero-dose” children can be avoided by joint interventions by the competent authorities at different levels, in particular parents, government authorities and technical and financial partners.

Impact of the COVID-19 Pandemic on Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in a Medicare Population.

The COVID-19 pandemic resulted in major disruptions in all aspects of human life including a decline of medical services utilized during 2020. An analysis of the impact of COVID-19 pandemic showed an 18.7% reduction in utilization patterns of interventional techniques in managing chronic pain in the Medicare population from 2019 to 2020. However, specific changes in utilization patterns of facet joint interventions have not been studied. Thus, we sought to assess the utilization patterns including an update of facet joint interventions from 2018 to 2020, with analysis of the impact of COVID-19 pandemic in managing chronic spinal pain utilizing facet joint interventions in the fee-for-service Medicare population of the United States. The present investigation was designed to assess utilization patterns and variables of facet joint interventions, in managing chronic spinal pain from 2010 to 2020 in the fee-for-service (FFS) Medicare population in the United States (US), and how the COVID-19 pandemic impacted these utilization patterns. Data for the analysis were obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2020. Results of this analysis showed significant impact of COVID-19 with overall decrease of 18.5% of all facet joint interventions per 100,000 Medicare population compared to 20.2 and 20.5% decrease for lumbar and cervical facet joint injections, 15 and 13.1% decrease per 100,000 Medicare population of lumbosacral and cervicothoracic facet joint neurolysis procedures. The results are significant in that comparative analysis from 2000 to 2010 and 2010 to 2019 showing an annual increase of 14.4 vs. 2.2%, illustrating a decelerating pattern. There were also significant growth patterns noted with decreases in facet joint injections and nerve blocks compared to facet joint neurolytic procedures. This analysis shows a significant effect of COVID-19 producing an overall decrease in utilization of facet joint interventions relative to pre-COVID data. Further, the analysis demonstrates continued deceleration of utilization patterns of facet joint interventions compared to the periods of 2000-2010 and 2010-2019.